Intoeing

Intoeing, which is commonly referred to as a child being pigeon toed, means a kid’s feet turn inward when walking or running, instead of pointing straight. In most young children, intoeing will correct itself without treatment. However, if it is still present after age 10, it is more likely to be permanent. It does not usually cause pain or lead to future problems like arthritis.

What are the signs of intoeing?

If your child is pigeon toed, you may notice the following:

• Outer edge of his foot is curved like a crescent moon, which is mainly noticeable in infants
• Shins or thighbones that may turn inward
• Limping, pain or swelling in his legs or feet
• Problems with the way he walks, such as tripping or clumsiness

At Children’s Healthcare of Atlanta, there are three causes of intoeing that our team of orthopedic specialists help diagnose and treat, including:

Metatarsus adductus (curved foot)

Metatarsus adductus is a condition in which the front of the foot is curved inward. It is typically noticed during infancy. The curve can be mild and flexible, severe and rigid, or anywhere in between. Metatarsus adductus usually improves on its own between 4 and 6 months old (particularly if it is flexible), and it typically resolves by 2 years old.

Stretching exercises are often recommended to help resolve the intoeing. During these stretches, a parent should hold a child’s heel firm between the thumb and index finger and use the other hand to gently push the front of the foot outward. This should be done several times a day, such as during diaper changes.

If the metatarsus adductus does not improve by the time your child is 6 months old, or if the curve is rigid (e.g., the curvature of the foot cannot be straightened during stretches), your child may need to see a pediatric orthopedic surgeon. If the condition is severe, a Children’s doctor may use a cast or special shoes to help correct the problem. Surgery is rarely used, except in the most severe cases.

Tibial torsion (twisted shin bone)

Internal tibial torsion is an inward twist of the tibia (shin bone). It occurs before birth but is often unnoticed until a child starts to walk.

Internal tibial torsion is diagnosed during a physical exam by looking at the thigh-foot angle (TFA), which is the angle between the middle of the thigh and the foot.

Tibial torsion almost always improves on its own before a child reaches school age and usually does not require treatment. Rarely, a child may need surgery if a significant twist does not go away and causes problems with walking.

Femoral anteversion (twisted thigh bone)

Femoral anteversion is an inward twist of the femur (thigh bone) near the hip joint. It causes the knees and feet to point inward when a child is walking.

Although this condition forms before birth, it does not often cause noticeable intoeing until a child is 2 to 4 years old. Normally, infants and young toddlers have limited ability to rotate their hips, which can masks the early intoeing caused by femoral anteversion. If a child has femoral anteversion, intoeing becomes more obvious as a child gains the ability to rotate his hips, and the intoeing is often most prominent between 5 and 6 years old. Children with femoral anteversion often prefer to sit in a “W” position, as opposed to a crossed-leg position.

Femoral anteversion is diagnosed by measuring a child’s hip rotation during a physical exam.

Your pediatrician may recommend further testing if she suspects your child is pigeon toed. This may include:

• Physical examination of your child’s legs by a pediatric orthopedic specialist
• Diagnostic imaging, including CT scans, to evaluate the alignment of your child’s leg bones
• X-rays or fluoroscopy (X-ray video) to observe your child’s leg bones in motion

Intoeing corrects itself without treatment in almost all children. However, a pediatrician may recommend treatment if your child develops severe problems. There are different options depending on the cause of the intoeing, including:

• Casts or corrective shoes for babies 6 to 9 months old who have severely deformed or rigid feet
• Pediatric orthopedic surgery to realign the shinbone or thigh bone in older children

Why choose Children’s for your child’s intoeing care?

From our orthopedic surgeons and nurses to our board-certified orthotists and anesthesiologists, the Children’s staff is trained to work solely with kids of all ages—0 to 18. Specifically, our Orthopedics Program is the top program in the Southeast and ranks nationally on the U.S. News & World Report list of best pediatric orthopedic programs. And, if your child requires sedation or anesthesia for treatment, our pediatric-trained anesthesiologists will never leave a child’s side. We can help your child overcome physical, emotional and social barriers to achieve his goals.

This content is general information and is not specific medical advice. Always consult with a doctor or healthcare provider if you have any questions or concerns about the health of a child. In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Some physicians and affiliated healthcare professionals on Children’s Healthcare of Atlanta team are independent providers and are not our employees.